Philippine Council of Deans and Educators in Business, Inc.

(PCDEB)

Search for PCDEB Outstanding Educator

NOMINATION FORM

Category/Field __________________________

Instruction: Please type/computer-print all information. Please submit two (2) copies. Deadline for
submission of entries is February 15, 2011.

If there is not enough space on the form to allow a complete answer, please type the additional
information on separate sheet/s.

I. PERSONAL BACKGROUND

_____________________________________________________________________
Full Name Surname Given Name Middle Name

_____________________________________________________________________
Residence Address and Telephone Number

_____________________________________________________________________
Business Address and Telephone Number

_____________________________________________________________________
Fax Number E-mail Address Mobile No.

_____________________________________________________________________
Birth date Birthplace Age

_____________________________________________________________________
Sex Citizenship Civil Status

1. EDUCATIONAL ATTAINMENT

School Attended Years Attended Degree Honors Received

Elementary
High School
College
Masters’ Degree
Doctoral Degree
Post Doctoral
Degree

2. TEACHING PERFORMANCE RATING FOR THE LAST TWO (2) SCHOOLYEARS

School Year Rating Verbal Interpretation

2008-2009
2009-2010
General Average

3. TEACHING EXPERIENCE (Please check if appropriate)

Teaching Background (Please start from current or most recent.)

School/s Rank Full Part Permanent/ Inclusive Dates Subjects
Time Time Probationary Taught

1
 4. EMPLOYMENT BACKGROUND

Employment History (Please start from current or most recent)

Company Name, Position/ Inclusive Dates Name and Nature of Business
Address and Designation Position of
Telephone Immediate Head
Numbers

5. RESEARCH

Title of Published Research Nature of Participation Name of Date of

Lead Research Publication Publication
Researcher Team
Leader

6. SCHOLARSHIPS/HONORS/AWARDS

Awards/ Citations Awarding Institution / Date Given

Organization

7. BOOKS/MODULES IN THE FIELD OF BUSINESS FOR TERTIARY EDUCATION

Title of Book Nature of Publisher / Date Published Nature of Authorship

Circulation
National One (1) Single Team/
School Co-
Only Author

8. SPEAKING ENGAGEMENTS FOR THE LAST TWO (2) YEARS

Topic / Title Event and Date Sponsoring Venue Status of Conference

Organization International University
Based

9. PROFESSIONAL ASSOCIATIONS/AFFILIATIONS

Name / Type of Position / Inclusive Extent of Involvement

Organization Designation Years
International National Regional

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 10. INVOLVEMENT IN COMMUNITY EXTENSION/ CIVIC/ RELIGIOUS/ CSR
ACTIVITIES FOR THE LAST TWO (2) YEARS

Activities Dates Attended Nature of Participation

11. INVOLVEMENT IN STUDENT ACTIVITIES IN THE LAST TWO (2) YEARS

Student Organizations Nature of Involvement Inclusive Dates

Please attach all pertinent documents to support all data indicated in this Nomination Form.
Nominee will be informed appropriately on the result of the preliminary screening.

CERTIFICATION
1) I hereby certify that the information I have submitted are correct to the best of my knowledge.
2) In case I will be selected as finalist, I will submit all pertinent documents to support all data
indicated in this Nomination Form one week after receipt of notice.
3) I will accept the award if it is bestowed upon me and I agree to be present during the awarding
ceremony in March 2011.

_________________________________ ____________________
SIGNATURE OVER PRINTED NAME DATE

Nominated by: Endorsed by:

__________________________ ______________________________________
Signature Over Printed Name University/School/College President’s Signature
Over Printed Name

_______________________________________
Name of the School

Please send your entry/documents with confidential cover to:

DEAN MA. FLORDELIZA L. ANASTACIO, Ph.D.
Past President, Philippine Council of Deans and Educators in Business (PCDEB)
Chair, Search for PCDEB Outstanding Business Educators
c/o Centro Escolar University, School of Accountancy and Management
Mendiola, Manila 1005
TelFax: (02) 735-9443
Telephone# (02) 735-6861 local 213/304
E-mail: mflanastacio@ceu.edu.ph
florieanastacio@yahoo.com